- Service Model Priorities
The purpose of the proposed enhanced services for Smoking Cessation is to implement a new 3-tier approach to smoking cessation services across the PCT. Tiers 1 and 2 will be delivered via Locally Enhanced Services.
The purpose of this LES is to implement a new 3-tier approach to smoking cessation services across the PCT. This service will be available to all residents in ESDW and H&R and will replace previous smoking cessation LES initiatives. The PCT is keen to target areas of highest need, that is, those wards with the highest smoking levels (and lowest life expectancy) and intendsprimary care practitionersin deprived areas to help drive this forward this key health improvement initiative in the 1st instance. The model proposes higher levels of engagement of primary care practitioners, increased services for smoking cessation provided by primary care practitioners and a new annual Smokers Health Check for all smokers. This new enhanced service will focus activity at prevention within practices, and any other suitable primary care service providers, and will reward for each element of activity for each patient.The smoking cessation services could also be deliveredon a clustered, or geographic basis.
This document, Smoking Cessation (Level 2), outlines service requirements & remuneration for Smoking Cessation Tier 2 only. The LES in respect of Level 1 services will be handled separately, and is currently still subject to negotiation with the ES Group.
It is proposed to develop a new 3 tier, managed service; simplistically this can be seen as overleaf:
The service details are shown in the following chart, together with the details of potential, new and expanded, multi agency providers:
Level
/Details of service
/ Potential Service Provider1 / Ensure patient level data is updated annually to provide accurate information on smokers within the population
Each smoker to be invited to attend an annual 1:1 health check, to focus on their health, and also the effects of smoking, with an aim to onward referral to a smoking cessation adviser
Level 1 Smoking Cessation
is detailed the Smoking Cessation LES (Level 1) / GP practice
GP practice
2 / Smoking cessation service – advice to patient, support (1:1 and on-going help sessions (and networking). Prescriptions issued where appropriate (free where individual is exempt from prescription charges)
DETAILED IN THIS LES / Pharmacy Enhanced Service, or
GP cluster scheme, or
Specialist Smoking Cessation Team
3 / Public Health (PH)
Targeted information schemes aimed directly at the populations particularly in the 20 wards. Specific emphasis on teenager/young people, smoking & pregnancy, the BME population, and cannabis cessation services. Working age (particularly manual worker groups), disease groups e.g. COPD, and then older adults
Monitoring of progress from QOF and from service (key performance indicators) from above
Training and advice/ support to practice staff and smoking cessation service providers
Level 3 Smoking Cessation
is not detailed in this document / Specialist Smoking Cessation Team (PH central)
- Smoking Cessation (Level 2)
This service may be provided by a Pharmacy Enhanced Service, or GP practice, or via a GP cluster scheme or any other suitable provider that can demonstrate competence to provide the service
TIMETABLE & PAYMENT SCHEME FOR LEVEL 2 SMOKING CESSATION SERVICEStage
/Service Specification
/Provider
/ Time / £Appt 1 / Initial assessment
identify readiness to quit and commitment to attending one to one sessions
Agree and sign client contract (see Appendix 1)
Take carbon monoxide (CO) reading
Set a quit date
Discuss NRT / Champix options.
Organize next appointment (if Champix is used, quit day appt needs to be 1 week after they have started on Champix)
Complete 1st section of monitoring form / GP practice or Pharmacy – accredited Practice Nurse or accredited Pharmacist/Specialist Advisors / 30
mins / £20.00
per person
Appt 2 / Quit day (set by patient)
Coping mechanisms
How are they getting on with NRT Plan for the week ahead – any social occasions?
Keep motivated
CO reading
Date of next meeting / GP practice or Pharmacy
– accredited HCA/Specialist Advisors / 15 mins / £10
Appt 3 / This can be a phone call or an appointment
Coping mechanisms
Keep motivated
CO reading (if appointment)
NRT / Zyban / Champix – any issues / problems
Date of next meeting / GP practice or Pharmacy – accredited HCA/Specialist Advisors / 10 mins / £0
Appt 4 / Same as appt 3
Date of next meeting / GP practice or Pharmacy – accredited HCA/Specialist Advisors / 10 mins / £0
Appt 5 / Same as appts 3 and 4
Date of next meeting / GP practice or Pharmacy – accredited HCA/Specialist Advisors / 10 mins / £0
Appt 6 / Four weeks follow up (i.e . 4 weeks after appointment 2)
Must be one to one meeting
Take CO validation reading
Does CO validate non-smoking status?
CO verification must be taken for final £40.00 payment to be made / GP practice or Pharmacy – accredited Practice Nurse or accredited Pharmacist/Specialist Advisors / 20 mins / £40
Total / A patient who has had 2 unsuccessful quit attempts should be referred to a Level 3 Specialist Smoking Cessation Service at the PCT / Max
1hr 40m / £70
NRT is available to all participants where applicable. Prescription charges apply.
Where Champix has been prescribed or issued, the provider must ensure a 12-week check up appointment with an appropriately trained member of staff; this is included within the above costing.
Where this service is provided by Community Pharmacies, medication costs will be covered by the dispensing budget. Service delivery costs will attract an additional payment of +17.5% VAT when appropriate.
Please note: The dispensing of Zyban and Champix under PGD from pharmacists has yet to be approved by the Medicine Policy Review Group and would entail appropriate PGD, training plus signing off by an appropriate clinical lead. The clinical lead for Investing in Life is the PEC Chair Dr Gregory Wilcox and the pharmacy lead is Sue Mills.
2.1.Service Criteria
The following criteria for this service will apply:-
2.1.1.All patients who present should have their smoking status recorded (Level 1) and their suitability assessed to progress to Level 2 of the programme.
2.1.2.If a patient is still smoking 2 weeks into the programme, though still trying to quit, a further week of NRT will be prescribed and appropriate advice given.
2.1.3.If at 3 weeks into the programme, total abstinence from smoking has not occurred, NRT, Advice and Support will be withdrawn.A discussion to re-evaluate the patient’s motivation to quit will take place at this point.
2.1.4.If more than 4 weeks of NRT is prescribed and the patient has not quit, they will be able to ask for further NRT/Zyban after 6 months following their last quit date (Advisers can use their own discretion with regards to individual cases according to personal circumstances)
2.1.5.Non-attendees should not be issued prescriptions if they fail to attend 2 consecutive clinics.
2.1.6.A patient who has had 2 unsuccessful quit attempts should be referred to a Level 3 Specialist Smoking Cessation Service at the PCT
2.1.7.A patient who “quits” smoking but restarts again can be re-entered into the Smoking Cessation programme and receive further NRT/Zyban/Champix after a 3 month period
2.1.8.Each monitoring form must be patient identifiable and a unique number given to each individual client. It is recommended that the Gold Standard Monitoring form is used (attached at appendix).
2.2.Training & Accreditation
2.2.1.General
Staff involved with the care of these patients must be appropriately trained and maintain their competence. Details and evidence of staff training and education relevant to the management of people undergoing smoking cessation initiatives, in accordance with training identified in section 6.2.2 and 6.2.3, must be provided at the time of sign up to this enhanced service. The PCT will not make payment for any services where they were delivered by any staff,that have not completed this training.
2.2.2.Level 2 Smoking Cessation Training for Pharmacists
Pharmacists will be required to Competencies and Training Framework as established by the Harmonisation of Accreditation Group. The training includes the completion of a Centre for Pharmacy Postgraduate Education (CPPE) Stop Smoking CD Rom open learning programme which provides pharmacists with the necessary knowledge to underpin the provision of this enhanced service:
The CPPE Stop Smoking CD Rom should be completed before or within 3 months of attending the PCT’s workshop. A record of completion of this pack must be kept and a copy sent to the PCT.
Pharmacists should also read:
- “Helping smokers to stop: advice for pharmacists in England” (ISBN 1-84629-035-X) published by NICE, RPSGB and PharmacyHealthLink. A copy can be downloaded from
- “Brief Interventions and Referral for Smoking Cessation in Primary Care and other Settings (Public Health Intervention Guidance No 1)” published by NICE. A copy can be downloaded from
It is also necessary to attend a PCT Workshop to enable Community Pharmacists to become competent to provide a Smoking Cessation Service at intermediate level, understanding the clinical, ethical, cultural and legal aspects of this work.
2.2.3.Level 2 Smoking Cessation Training for Specialist Advisors
This is a 2-day course, incorporating pharmacological and behavioural therapies to enable staff to work with clients who want to stop smoking. This is available through the PCT’s Learning and Development Department. This course must be completed prior to commencing Level 2 service delivery. A 2-hour annual update session must be attended to maintain best practice in smoking cessation.
2.3.Record Keeping
Providers will maintain adequate records of the monitoring provided for the purposes of annual audit. Providers will be expected to maintain a minimum data set identified by the PCT to monitor demand, volume, cost, KPI’s and their associated quality outcome indices in accordance with data requirements as detailed below.
2.4.Monthly Reports (Level 2: Stage 2)
The Provider will submit a Monthly Report to the PCT. The Monthly Report will run from 1st to the 31st (or last day) of each month.The PCT will require information to help determine which interventions are most effective in improving health and health outcomes and that represent good value for money. It will contain the following:
2.4.1.Number of New participants / People Attending
2.4.2.Number of Existing participants / People Attending
2.4.3.Number of drop-in clinics held (general practice only)
2.4.4.Number of workplace clinics held (general practice only)
2.4.5.Referral source
2.4.6.The number of clients entering treatment who have set a quit date
2.4.7.The number of clients who have been recorded as successful four-week quits (quit – self report / quit - CO verified / not quit / lost to follow up)
2.4.8.Therapy used (NRT, gum, Zyban, Champix or none)
2.4.9.Above indicators analysed by unique patient identification number, age, sex, occupation, ethnicity, postcode, prescription exemption
2.4.10.Quarterly in-house monitoring of SHA returns data to identify all indicators down to ward level
The Provider should use the relevant Monitoring Form to provide the required data and checking whether the client is prepared to give signed consent for future follow up. This will enable the PCT to conduct audit work around the impact of interventions and prevalence. Reports should show indicative data at points in the process to show how many people start the programme, at what point they drop out, and how many people achieve the 4-week quit target. The provider must maintain auditable records for the above at their own premises, and the PCT retains the right to audit such records.
2.5.Annual Report
In addition, the Provider will submit an Annual Report to the PCT (in accordance with section 6.7). The annual report will cover the twelve month period, from 1st April to the 31st March, for the previous financial year. It will include the following:
2.5.1.1.An aggregate of the monthly reports.
2.5.2.The finding of a patient’s survey of satisfaction and well-beingand any findings from work involving the public and patients.
2.5.3.Public & Patient Involvement
The provider will ensure systems are in place to gather information on the patient experience, in line with the patient experience metrics (questions) being developed in house for South East Coast.
The Report may be checked by the PCT, who retain the right to confirm the accuracy of information submitted. The PCT also reserve the right to conduct an independent audit of all findings and results.
2.6.Additional Quarterly Reports to Professional Bodies
The provider may be required to submit additional reports to relevant or professional bodies in ESDW and Hastings & Rother, as required, on a quarterly basis. This may include:
2.6.1.Enhanced Services Groups
2.6.2.PCT Boards
2.6.3.PEC
2.7.Submission Dates
Monthly reports:On/ by the 15th of each month commencing on the 15th of the following month from the commencement of the service on the relevant Monitoring Forms
Annual reports:For the period of 1st April to 31st March in any fiscal year by 30th April 2009 (Annual End of Year)
Smoking Cessation Level 2
Submissions will be made to the Primary Care Trust
2.8.Formal Review
A full & formal review of this Enhanced Service will be undertaken in
July 09.
2.9.Finances & Remuneration
The payment scheme is intended to reflect clinical practice, acknowledging that it is not always possible to have 6 appointments, and the initial assessment, quit day and 4 week follow-up appointments are most critical.
2.9.1.Payments will be made 1 month in arrears post submission of monthly report
2.9.2.The fee for appointment 1 will be £20
2.9.3.The fee for appointment 2 will be £10
2.9.4.The fee for appointments 3,4 & 6 will be £40 dependent on receipt of CO2 validation but will only be payable for those patients that are 4 week quitters
2.9.5.The fee for recording a patients smoking status will be covered under QOF
2.9.6.Total fee possible per person is £70 per annum
2.9.7.Payment will not be made for “did not attends”
2.9.8.Payment for Appointment 1 will be made upon submission of Initial Assessment.
2.9.9.Payment for Appointments 3 – 6 will be made upon submission of the number of people who have achieved the 4-week quit target and who have a reduced CO2.
2.9.10.Submissions should be made to the
- Breach
All contractors are expected to provide essential services they are contracted to provide for all their patients. The enhanced service specification outlines the more specialized services to be provided. The specification of this service is designed to cover the enhanced aspects of clinical care of the patient, all of which are beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential services.
Breach of conditions of this contract may result in a reduction or withdrawal of payment and cancellation of this contract.
- Equity
This service must be provided in a way that ensures it is equitable in respect of race, creed, culture, diversity, disability, age, etc..
- Application Process
Applications are invited to provide and/or deliver this service from general practice, community pharmacies and any other provider as relevant.
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